Halitosis or Bad Breath

Bad breath or halitosis is a common condition - There are medical reasons for bad breath, such as diabetes or infection, but someone who's studying the common or garden form, in otherwise healthy people, is Dr Beatrice Gandara of the University of Washington, Seattle.

Transcript

Well bad breath or halitosis is a common condition - and for some reason, I can't imagine why, mostly experienced by other people. There are medical reasons for bad breath, such as diabetes or infection, but someone who's studying the common or garden form, in otherwise healthy people, is Dr Beatrice Gandara of the University of Washington, Seattle.

Dr Gandara: Bacteria breaking down protein in the mouth is what produces these compounds called volatile sulphur compounds that are sort of the essence of bad breath. Everybody can have bad breath at some point, and usually the most common time is like first thing when you wake up in the morning - morning breath. And that's very common and it doesn't indicate bad health, or anything like that.

Norman Swan: And is that due to dental hygiene - it's just that there's been food trapped in your mouth and it's been rotting overnight?

Dr Gandara: Yeh. Well, it probably mostly has to do with the fact that when you are sleeping your salivary flow goes down, so your mouth is drier and you don't have the constant mechanical flushing that saliva performs during the day when you are awake. And so you do get some stagnation if you've got any plaque, bacteria that's in everybody's mouth and is accumulation of these by-products that can cause oral odours, oral malodours.

Norman Swan: Some people say that it's due to dehydration. That you simply haven't drunk enough overnight, or during the day, and when you haven't drunk enough that makes your real breath smell.

Dr Gandara: That's true, because if you do get dehydrated your salivary flow will go down. You get a sense of dry mouth. Somebody who does extensive exercise and doesn't rehydrate, your mouth feels dry. Or if you're, you're anxious, your mouth will turn to dry. I mean it's just physiologic response, and sometimes that's when you smell bad breath on people, you know if they're really, kind of dry mouth.

Norman Swan: So you sheet it home to the flow of salivary fluid.

Dr Gandara: That's one of the causes. Dryness or decrease in salivary function. But probably the most common cause is having a high level of bacteria in the mouth, from poor oral hygiene and having inflammatory by-products of having gingivitis, periodontitis, deep pockets around the teeth where debris and bacteria accumulate.

Norman Swan: And what it is you're smelling?

Dr Gandara: What you're actually smelling is a group of compounds known as volatile organic sulphur compounds. In sulphur is malodorous anyway. It's a, what you get from a rotten egg, you know sulphur smell. And there's some compounds that are in a group called diamines and they've got really interesting names like Cadaverine and Putrescine and are very graphic names. And they also contribute to oral malodour, and those would not be picked up by a haliometer for example, which is the bad breath measuring device, because that measures sulphur containing compounds.

Norman Swan: Is simply, drinking a glass of water, washing your teeth, flossing, what's known to work, apart from sucking a peppermint?

Dr Gandara: Well actually, when you suck peppermints or things, that usually just temporarily fixes. Usually you wake up in the morning, you have morning breath, you brush your teeth and you rinse out, and everything's okay. If it persists beyond having normal oral hygiene procedures, then that could be indicative of further problem. You know, like having periodontal disease, or tonsillar crypts, you know they catch debris and you can't quite get to those. I think to have full halitosis care, you have to make sure what's causing it, so there's not one answer to one treatment.

Norman Swan: What is saliva?

Dr Gandara: Well saliva is fluid secretion from three sets of paired salivary glands, two paired sets underneath the tongue, kind of running underneath the end of the mandible and there's a paired set that are right in front of your ears.

Norman Swan: The ones that get swollen in mumps?

Dr Gandara: Yeh, exactly, and hundreds of minor salivary glands that are very superficially situated in the soft tissues of our mouth.

Norman Swan: And what you've found in some research, is that one of the reasons why saliva might decline as people age is not the big glands, it's those multiple little ones that are scattered throughout the mouth.

Dr Gandara: Well, actually the major cause of having a decrease salivary flow is medications, that's one of the most common cause.

Dr Gandara: As people get older they're taking, more likely to take high blood pressure medications, or any psycho active drugs tend to cause dry mouth, meaning anti-depressants, anti-anxiety agents, anti-psychotic agents. And there's been studies that show that flow decreases actually with the number of medications regardless of the type almost. I mean, if somebody's taking five medications regardless of what type they are, they're going to have more of a chance of having a lower flow rate. With minor gland we tried the ones where there are hundreds in the mouth, I think that's pretty much proven that they do decrease with ageing.

Norman Swan: Now dry mouth often goes with dry eye in people where it's not a drug side effect. What's going on there?

Dr Gandara: If someone is not taking medications, that are known to cause dry eyes, or dry mouth, and they have dry eyes and dry mouth, then one would have to at least rule out the possibility of having an auto-immune disease, in particular one called Sjoegren's syndrome.

Norman Swan: Do post-menopausal women suffer dry mouths as well?

Dr Gandara: I know that in the peri-menopausal period, as well as having hot flushes, and other things, you know, mood changes and things like that - it's commonly reported to have oral problems, dry mouth, burning tongue, bad taste in the mouth, and talking now, just about the dry mouth aspect of it, there is a colleague of mine by the name of Jonathan Ship, who's at Ann Arbor, Michigan - and he ran a study on post-menopausal women and found that when they actually measured the flow rates that there was no difference between post-menopausal and pre-menopausal. And so I think there is a sensation of dry mouth where there may not actually be a decrease in salivary function.

Norman Swan: Now with dry eye, people drop in saline drops into the eye. Dry mouth, you simply drink regularly?

Dr Gandara: At the most basic you want to be well hydrated, and that's good for your body anyway. With salivary dysfunction, or in particular, low flow rate, usually my first approach is to try to optimise what's there - because no artificial saliva is as good as your own saliva, and using stimulants, like taste stimulants, flavoured chewing gums, candies that don't have sugar will increase the salivary flow rate. So that's what you always start out with. And some people who have auto-immune disease or head and neck radiation, which is, you know really fry the gland so to speak, so they have no function, then you have to resort to external moistening and then you have to go to an artificial saliva. Most people don't like artificial saliva because the texture's not quite right, or it doesn't taste good.

Norman Swan: How do you take it?

Dr Gandara: You just squirt it in the mouth. It can come in spray form, or goop form and, just use it as an external moistener.

Norman Swan: So will we try this halitosis analyser?

Dr Gandara: Sure

Norman Swan: So, we're sitting here in front of this essentially a medium sized grey box with a plastic tube coming out of it - can you tell me what it does?

Dr Gandara: It takes a sample of air and if you have it in the mouth it would be breath air - and measures the amount of volatile sulphur compounds without discriminating between any kind of.. and gives the units and parts per billion. And according to the manufacturer, levels below 200 are considered within normal and above 300 and research studies has been show to be consistent with bad breath.

Norman Swan: So what we have here is this plastic tube and you put a straw, a cut off straw on the end of it. You've asked me to hold the end of the straw where it goes into the tube, yeh, and I put it into my mouth and what then.

Dr Gandara: Yeh, put your lips up to where your fingers are so that it goes into your mouth, into the cavity of your mouth, and we look at the numbers here and it's going to be going..... it only went up to 196.

Norman Swan: How do I rate then... on the non nose test?

Dr Gandara: On the non nose test I would say that would be within normal range.

Norman Swan: What a relief. Dr Beatrice Gandara is in the Department of Oral Medicine at the University of Washington, Seattle.